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Flashcards in Required Reading-Preop/Airway Deck (51):
1

Majority of anesthetic complications are due to ___ injuries; these result from ____.

respiratory; difficult intubation, difficult airway, poor dentition

2

Factors affecting mask ventilation (5)

(1) Beard (2) BMI>26 (3) Missing teeth (4) Age>55 (5) Snoring

3

Determine preop CV functional capacity with _____. A score of greater or equal to ____ have better periop outcomes in NONcardiac surgery.

metabolic equivalent [MET] activity; 4 [raking leaving, weeding or pushing power mower; MET scores 1-12]

4

If sx not urgent, then active cardiac condition/clinical risk factors should be assessed preop. If cleared, low-risk sx have

endoscopic procedures, superficial procedures, cataract, breast, most ambulatory surgeries

5

Intermediate-risk sx for CV include ____. High-risk sx include ____

intraperitoneal, intrathoracic, carotid endarterectomy, head/neck, orthopedic; aortic, major vascular, peripheral vascular

6

Patients with a MET

heart rate control; cardiac testing

7

Pulmonary patient-related periop risks:

smoking, poor general health (ASA>2), age>70, obesity, COPD, reactive airway dz (asthma)

8

Pulmonary PROCEDURE-related periop risks:

surgery >3hr, gen anesthesia, type of sx, pancuronium

9

Risk reduction for pulmonary risks (A) preop (B) periop (C) postop

(A) smoking cessation for 8wks, tx COPD/asthma, Abx for URI, incentive spirometry (B) limit

10

Important to remember that hepatic dysfunction can cause ____ and ____.

altered coagulation; altered drug pharmacokinetics

11

GI dz can increase potential of ____, ____, ____ and ___.

aspiration; dehydration; electrolyte disturbances; anemia

12

All diabetics should be evaluated for ____, ____ and _____. Most docs will avoid ___ anesthesia due to peripheral neuropathy.

CAD, HTN, nephropathy (Cr levels); regional

13

Diabetics need to take ___ of morning dose insulin on day of surgery; if elective, should do earlier in day to avoid _____.

half; prolonged fasting

14

Physical exam consists of vitals, airway eval, cardiopulm, GI, MSK and neuro exam. Airway exam assesses ___

Mallampati score, facial trauma, large incisors, beard, large tongue, neck masses, tracheal deviation, thyromental distance (

15

Important to look at chronic pain and ___ use, because may lead to increased requirements during surgery. Also look for long-term ___ use, which can lead to ____ and may require supplementation during sx.

opioid; steroid; adrenal insufficiency

16

Supplements: ___ and ___ can potentiate anticoagulation meds, ___ can prolong anesthesia, ___ can cause arrhymias

ginko; garlic; St Johns Wort; Ephedra

17

Poss preop studies and indicated dz: (A) CBC (B) T/S & albumin (C) PT/PTT (D) Electrolytes

(A) CBC; EtOH, anemia, radiation therapy, etc. (B) T/S & albumin; hematologic dz, malnutrition (C) PT/PTT; hepatic dz, Fhx bleeding, anticoag (D) Electrolytes; renal dz, DM, etc.

18

Poss preop studies and indicated dz: (E) BUN/Cr (F) Glucose (G) AST/ALP (H) EKG (I) CXR

(E) BUN/Cr; cancer w/ chemo, renal dz, digoxin/diuretics (F) Glucose (G) AST/ALP; EtOH, cancer w/ chemo, statins (H) EKG; statins, digoxin, radiation, etc. (I)CXR; smoking hx, radiation therapy, rheumatoid arthritis, etc.

19

The purpose of the ____ is to discuss w/ pt or rep the types of anesthetic options available for planned procedure and explain risks/benefits

anesthesia consent form

20

ASA Class ___ is a normal and healthy patient

1

21

ASA Class ___ is a pt w/ mild systemic dz

2

22

ASA Class ___ is a pt w/ severe systemic dz that limits activity, but is a constant threat to life

3

23

ASA Class ___ is a pt w/ incapacitating system dz that is constant threat to life

4

24

ASA Class ___ is moribund pt not expected to survive 24h w/ or w/o sx

5

25

ASA ___ designates emergency surgical procedure

E

26

If a pt is perceived as difficult to intubate/ventilate, obtain ____.

fiberoptic equipment and skilled help

27

If pt has heart dz/valve dz or risk of subacute bacterial endocarditis, consider ____ 1h prior to sx

prophylactic abx

28

If pt Fhx malignant hyperthermia, have ___ ready

dantrolene

29

If pt on MAOIs, discontinue therapy preop if pt not ____ and plan for periop pain therapy

suicidal

30

If pt has peripheral motor neuropathy, avoid _____ drugs

depolarizing muscle relaxants

31

If pt pregnant, use ____

oral antacids [monitor FHTs]

32

Types of anesthesia are __, ____, ___ and ___

general, MAC (monitored anesthesia care), regional, local

33

The best way to assess CV risk is asking about ____

exercise tolerance

34

DO NOT quit smoking w/in a short period before sx because will increase ___ and ____ temporarily. Must try to quit greater than ___ weeks preop.

coughing; sputum production; 8

35

Difficult laryngoscopy is defined as when no portion of ____ is visualized.

glottis (vocal cords and space)

36

Medical conditions that portend difficult airway include ___

hx facial trauma/sx, rhuematoid arthritis, pregnancy, epiglottitis, previous cervial fusion, neck masses, Down's syndrome, Treacher-collins, Pierre-Robin abnormalities

37

Increasing difficult laryngoscopy correlated with Mallampati Class ____ and ___

3; 4

38

Mask ventilation needs optimal ____, ____ visualized as pt in "sniffing" position, and sufficient ____ to overcome resistance of upper airway.

seal; oropharynx; positive pressure

39

Mask ventilation is to augment a pt's spontaneous ____ before definitive airway management.

tidal volumes

40

___ can be used in pts receiving gen anesthesia w/ no endotracheal intubation and in situations when mask vent is difficult.

LMA

41

LMA does NOT enter the _____, therefore pts tolerate it with less anesthetic; also, LMA does NOT protect against ____ to same degree.

glottis; pulmonary aspiration

42

Contraindications to LMA include ___, ____, ____ and ___

increased risk pulmonary aspiration; pts w/ PEEP ventilation; long procedures; any position other than supine

43

Common errors in direct laryngoscopy include ____ and ____

inserting blade too deeply; improperly sweeping tongue from line of signt

44

MC laryngoscope blades are ____ [curved} and ____ [straight]

Macintosh; Miller

45

Because of anatomical narrowing at level of cricoid cartilage in children ____ tubes are used and a seal forms directly between tube and trachea.

uncuffed

46

Endotracheal intubation is gold standard b/c reduces possibility of ____ and increases amount of ____ that can be achieved via mech ventilation.

aspiration via gastric juices; positive airway proessure

47

Risk factors for aspiration have to do with having eaten and include :

trauma pts, emergency sx (not fasting), pregnant pts in labor, GERD, DM/obesity, neurological impairment

48

In order to dec time when pt awake (intact laryngeal m protecting from aspiration) and endotracheal tube, a ____ can be done.

RSI (rapid sequence induction)

49

Rapid sequence induction does NOT use ____ (avoiding stomach distention), ____ pressure is maintained , and ___ is muscle relaxant drug of choice

mask ventilation; cricoid [surrounds trachea and will collapse esophagus lumen]; succinylcholine [rocuronium if burn or SC injury pts]

50

Fiberoptic intubation can be accomplished in ____/____ patients.

awake [w/ local anesthesia]; anesthetized

51

Two types of video assisted endotracheal intubation include ___ and ___ and are used if limited mouth opening.

Glidescope, C-Trach